Shao Weipeng, Huang Jingjing, Feng Hongxiang, Sun Hongliang, Ren Yanhong, Wang Xiaowei, Zhang Zhenrong, Liu Deruo
Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China.
Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Transl Cancer Res. 2020 Feb;9(2):1151-1159. doi: 10.21037/tcr.2019.12.88.
To evaluate the effect of interstitial lung disease (ILD) on postoperative morbidity and mortality in pulmonary resection and identify the factors of AE-ILD.
We retrospectively analyzed 1,309 patients underwent pulmonary operation between January 2010 and January 2018 in our hospital. Clinical data including age, sex, history of chronic obstructive pulmonary disease (COPD), smoking history, smoking index, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), forced expiratory volume in 1 s (FEV1) % predict, surgical procedure, video-assisted thoracoscopic surgery (VATS) or not, intraoperative blood transfusion, anesthesia time, operation time/one-lung ventilation time, blood loss, histology, postoperative morbidity, 90-day mortality, onset of acute exacerbation of ILD (AE-ILD), and postoperative stay were collected and analyzed.
There were 97 (7.4%) and 1,212 (92.6%) patients in the ILD and non-ILD groups, respectively. AE-ILD occurred in 6 patients (0.5%), with a mortality of 83.3%, and was the leading cause of 90-day mortality (55.6%). Age (P<0.001) was an independent risk factor for ILD. There were 6 and 91 patients in the AE-ILD and non-AE-ILD groups, respectively. ASA classification (P=0.038) were independent risk factors for AE-ILD. Multivariate regression analysis identified that the sex (P=0.003), ILD (P<0.001), COPD (P=0.007), surgical procedure (P<0.001), blood loss (P<0.001), CCI (P=0.049) were independent risk factors for postoperative morbidity. ILD (P=0.001) and postoperative morbidity (P=0.003) were independent risk factors for 90-day mortality in multivariate analysis.
Patients with ILD had a higher incidence of postoperative morbidity and 90-day mortality. ASA classification was an important influencing factor for AE-ILD. Based on the obvious postoperative morbidity and mortality, special attention and management should be given to ILD patients.
评估间质性肺疾病（ILD）对肺切除术后发病率和死亡率的影响，并确定急性加重型ILD（AE-ILD）的相关因素。
回顾性分析2010年1月至2018年1月在我院接受肺手术的1309例患者。收集并分析患者的临床资料，包括年龄、性别、慢性阻塞性肺疾病（COPD）病史、吸烟史、吸烟指数、美国麻醉医师协会（ASA）分级、Charlson合并症指数（CCI）、第1秒用力呼气容积（FEV1）占预计值百分比、手术方式、是否为电视辅助胸腔镜手术（VATS）、术中输血情况、麻醉时间、手术时间/单肺通气时间、失血量、组织学类型、术后发病率、90天死亡率、ILD急性加重（AE-ILD）的发病情况以及术后住院时间。
ILD组和非ILD组分别有97例（7.4%）和1212例（92.6%）患者。6例患者（0.5%）发生AE-ILD，死亡率为83.3%，是90天死亡率的主要原因（55.6%）。年龄（P<0.001）是ILD的独立危险因素。AE-ILD组和非AE-ILD组分别有6例和91例患者。ASA分级（P=0.038）是AE-ILD的独立危险因素。多因素回归分析确定，性别（P=0.003）、ILD（P<0.001）、COPD（P=0.007）、手术方式（P<0.001）、失血量（P<0.001）、CCI（P=0.049）是术后发病的独立危险因素。在多因素分析中，ILD（P=0.001）和术后发病（P=0.003）是90天死亡率的独立危险因素。
ILD患者术后发病率和90天死亡率较高。ASA分级是AE-ILD 的重要影响因素。鉴于明显的术后发病率和死亡率，应给予ILD患者特别关注和管理。
